SHM’s scott Flanders, MD, of the University of Michigan Health System, and Sanjay Saint, MD, MPH, a hospitalist at the Ann Arbor VA Medical Center and University of Michigan Health System, are spearheading the nation’s first multi-hospital patient safety project to protect hospital patients from errors and oversights. The project, called Hospitalists as Emerging Leaders in Patient Safety, or HELPS, will coordinate the efforts of nine southeast Michigan health systems, allowing hospitalists from around the region to share tips, tools and techniques. It also will help doctors put proven safety ideas into motion at their hospitals and measure how well this pooled effort can prevent such problems as medication errors, hospital-acquired infections and dangerous falls.
The patient safety project was launched in April via an $117,000 grant to the University of Michigan Health System from the Blue Cross Blue Shield of Michigan Foundation. This is the latest of several recent patient safety-related grants awarded to the University of Michigan by the Blue Cross Blue Shield of Michigan Foundation.
“Although patient safety relies on every member of the hospital staff to take appropriate actions and to speak up when something goes wrong, the buck stops with the physician who leads the inpatient team – and increasingly that physician is a hospitalist,” said Dr. Flanders, chief of the hospitalist service at UMHS, associate professor of medicine and member of the SHM board of directors. “Health systems are hiring hospitalists to maximize inpatient care efficiency, coordination and patient satisfaction, while lowering the costs of care,” added Dr. Flanders. “An integral part of these goals should be to improve patient safety by reducing medical errors.”
Dr. Saint, an associate professor who heads the Patient Safety Enhancement Program at the Ann Arbor VA Medical Center and UMHS, credits much of the impetus for HELPS to the Agency for Healthcare Research and Quality and the VA’s Health Services Research and Development Program, both of which have supported previous patient safety work that forms much of the basis of this new project. Dr. Saint and hospitalists at the University of Michigan have already shown that they can reduce urinary tract and bloodstream infections among hospitalized patients by using reminders and automatic orders to prompt doctors, and by standardizing the use of new site disinfectants and novel antibacterial catheters. This effort alone is saving UMHS hospital patients considerable pain and risk, while lowering UMHS costs, despite the fact that the new technology costs more initially. Drs. Flanders and Saint will attempt to repeat this success in hospitals across the southeast region in nine different areas of medicine, including:
- Techniques for performing quality-improvement research, so that doctors can accurately assess the effects of their efforts;
- Preventing device-related infections;
- Eliminating medication errors and creating a culture of safety;
- Improving the use of preventive medications for surgical patients;
- Closing gaps in care between different services in the hospital and gaps that exist as patients are discharged from the hospital;
- Improving intensive-care practices, including pneumonia prevention;
- End-of-life care, including pain and advance directives;
- Safety for older patients, including prevention of falls and delirium; and
- Learning lessons from patient safety efforts.
The nine participating Michigan health systems include:
- University of Michigan Health System
- VA Ann Arbor Healthcare System
- St. Joseph Mercy Healthcare System
- Oakwood Healthcare System
- Beaumont Hospital
- Detroit Medical Center
- Henry Ford Health System
- Chelsea Community Hospital and
- Michigan Hospitalists, who practice throughout the St. John Health System.
In all, the hospitalists in the new consortium care for about 80,000 patients each year.
“Linking these key hospitals, where hospitalists care for so many patients, will make a huge difference in patient safety in southeast Michigan,” said Dr. Saint. “We’ll all now have the advantage of cross-sharing patient safety tactics that work, instead of allowing that knowledge to stay within one hospital or health system. We will also focus on which implementation strategies are likely to work and which ones should be abandoned.”
In addition to its cross-sharing of patient safety information, UMHS will also provide expertise in patient-safety research and statistical analysis that will boost the project’s impact. The hospitalist team hopes to publish its data about safety-enhancing practices that show the most promise―and about how to persuade and remind doctors to use safety-enhancing practices. The team has already begun publishing work related to HELPS. The manuscript describing this unique consortium was recently accepted in the Journal of Patient Safety.
The UMHS hospitalist practice currently cares for nearly half of the adult patients admitted to the internal medicine services of University Hospital. UMHS has also added a team of pediatric hospitalists. In addition to the patient safety project, UMHS hospitalists are pioneering co-management of surgical patients with orthopaedic surgeons.
Drs. Flanders and Saint also anticipate that their nine-hospital consortium will eventually develop into a multicenter collaborative in which clinical studies―both experimental and observational―will be conducted. They expect that hospitalists, working closely with specialist colleagues, will be actively engaged in creating the new knowledge that is increasingly required to care for hospitalized patients. Importantly, this knowledge will come not just from patients admitted to tertiary-care academic medical centers, but also community hospitals, the venue in which the majority of hospitalized patients receive care. Similar to the success of cardiologists and oncologists in establishing regional, national, and international networks of clinical investigators, Drs. Flanders and Saint would be thrilled if HELPS is viewed in a decade as birthing a hospitalist network of clinical research excellence. Given the high level of support that has been provided by the UMHS and the enthusiastic response HELPS has received from each of the participating sites, Saint feels they are well on their way.
Flanders says that more and more, hospitalists will become the linchpins to patient safety improvement. “It would be extremely difficult to coordinate the efforts of the thousands of independent, community-based doctors who spend part of their time caring for inpatients,” he said. “By spearheading this effort through hospitalists, we can change the system from the inside out, and help spread patient safety best practices to other physician specialists, primary care doctors, nurses and every member of the patient care team.”